Evidence-based HIV prevention in community settings: provider perspectives on evidence and effectiveness

Abstract

As part of the efforts to expand evidence-based practice (EBP) in HIV prevention at the community level, the Centers for Disease Control and Prevention (CDC) created the Diffusion of Effective Behavioral Interventions (DEBI) program. Frontline service providers, who are charged with adopting and implementing these interventions, however, have resisted and criticized the dissemination of evidence-based HIV prevention interventions. Their failure to implement the interventions with fidelity and abandonment of plans to implement interventions in which they were trained have often been discussed from the framework of 'capacity-building'. This framework points to 'deficits' within communitybased organizations (CBOs) that impede the uptake of EBP. This article presents the perspective of 22 frontline service providers from CBOs (n ¼ 8) in a Midwestern state on their experiences with the DEBI program, and illustrates the reasons providers may not implement EBP. Analysis of interview responses reveals that providers cite diverse reasons -beyond organizational capacity -for lack of implementation with fidelity. Specifically, they offer critiques of the DEBI program based on the models of evidence of effectiveness on which it is based.

How do third sector organisations use research and other knowledge? A systematic scoping review

“…Six studies were from Canada, two from the USA and two from the UK. The services provided by the TSOs included in the studies concerned HIV/AIDS care [ 18 , 19 , 29 – 31 ], child welfare services [ 28 ], diabetes care [ 30 ], addictions care [ 15 ], adult mental health services [ 18 ], child mental health services [ 32 ] and social welfare and health care services [ 33 ], or was mixed across domains of health and social care.…”

“…Four studies looked at the processes of implementation of evidence-based interventions or programmes by TSOs [ 16 , 29 , 31 , 32 ]. Four studies looked at how TSOs use research knowledge in their work and decision making [ 18 , 28 , 30 , 34 ].…”

“…Five studies reported that TSOs use a range of information in decision making and service delivery [ 15 , 29 , 31 , 33 , 34 ]. Sources of knowledge included staff professional experience and client views and wishes [ 15 , 29 , 31 , 33 ]; and in some of these studies [ 29 , 33 ], staff and client knowledge was preferred over other sources of knowledge.…”

“…Five studies reported that TSOs use a range of information in decision making and service delivery [ 15 , 29 , 31 , 33 , 34 ]. Sources of knowledge included staff professional experience and client views and wishes [ 15 , 29 , 31 , 33 ]; and in some of these studies [ 29 , 33 ], staff and client knowledge was preferred over other sources of knowledge. For example, Dolcini’s study [ 29 ] identified organisational culture as a barrier to the implementation of evidence-based HIV practice, insofar as it was not seen as part of the culture in CBOs to rely solely on evidence-based practice; instead, there was a preference for using their own knowledge of what works, or borrowing programmes and ideas from organisations that run similar services.…”

“…In Owczarzak’s study into evidence-based practice for HIV prevention services [ 31 ], interviewees differentiated between “book” and experiential knowledge, where book knowledge was used to support intervention implementation and experiential to challenge it. The “borrowing” of ideas from others was a source of knowledge in Jack et al’s study [ 15 ].…”